Sick-Day Dilemma: How to Make the Call for Your Kids

It’s 6:30 a.m. on a Monday and you’re well into your morning routine, but something’s missing—there was no five-year-old pouncing on your bed to wake you. You dash to her room, find her still in bed and feel warmth radiating from her as you nudge her to wake. Her temperature reads 101.8°F, she lacks her usual vigor and there’s an intermittent cough.

Your kids need to be ready in a half-hour for you to make it to work on time. What do you do? Should you keep your young one home? Or send her off to school?

As a parent, it can be difficult to call to make. It’s even harder when a day at home sick disrupts other schedules, or when you get the call to pick up your sick child from school or daycare.

UR Medicine Primary Care’s Dr. Michael Gavin shares these tips on when to consider keeping your child home, as well as when to call the doctor:

Know the fever facts. A child under 3 months of age with a fever (100.4°F or higher) should be seen by a doctor immediately, usually in the emergency department. In older kids, fevers aren’t necessarily a bad thing as long as they aren’t exceptionally high. They indicate that the body is fighting an infection. However, if a child has a temperature of 104°F or higher, no matter what the age, you should at least call your doctor’s office to see if they should be evaluated.

Trust your gut. One of the most valuable and accurate tools you have is your own parental instincts, so go with your gut. Even with all of the medical evidence and tests out there, parents know their children best. As pediatricians, one of our most important exam findings is the child’s general appearance. Therefore, if they don’t appear right to you, keep them home. If you’re concerned or worried about how your child appears (i.e., “They usually don’t seem this tired when they’re sick”) then bring them in to see their doctor.

On the other end of the spectrum, it’s also important to consider if your 15-year-old is pulling a Ferris Buller to get out of a test. If you suspect there may be secondary gain, investigate. It could be school avoidance due to bullying or other stressors, which should also be addressed. This is more likely if they have repeated illness days that don’t coincide with their symptoms.

Give it a try. It’s okay to send them to see if they get better throughout the day. If they weren’t up for it, then you can pick them up later. If you do need to pick them up, don’t blame yourself for making the "wrong decision” in the morning. It can be very difficult to tell which way an illness is going to go, especially in the morning.

Note their breathing and any cough. Respiratory problems are a frequent cause of illness, especially in the winter months. Certainly if it appears your child is having difficulty breathing or having a constant cough, wheezing, or noisy breathing, bring them in immediately to be assessed. However, a cough that is intermittent and mildly bothersome by itself does not always mean they should stay home, especially if it’s after a viral illness. Coughs can last 6 to 8 weeks after an illness. If your child appears well but still has a cough, they may not need to be evaluated. One exception to this is if your child has asthma or a respiratory disorder, in which case this could mean their underlying disorder is uncontrolled.

Are they contagious? Concern for spread of disease is thoughtful, but many illnesses are spread even before a child starts having symptoms. Therefore, wanting to prevent others from getting ill should not be a major reason to keep a child home. Instead, kids should learn the importance of hand-washing before they get sick.

An exception to this is conjunctivitis or pink eye. Symptoms of this may persist for 3 to 7 days, and can be caused by viruses as well as bacteria. When tearing and matted eyes are no longer present, it's appropriate for a child to return to school or child care. If it’s caused by a bacteria, children may return after 24 hours of treatment.​

Diarrhea and vomiting warrant a sick day. Most daycares and schools have illness policies about these symptoms. If a child appears to be dehydrated, they should be evaluated urgently. For babies, this means less than three wet diapers in a day. For older kids, it means dry mucous membranes, decreased tear production, as well as very dark, infrequent urination.

The bottom line: There isn’t one right answer. Parents should make a decision based on how their child appears and whether the child can effectively participate in their school day, and assess their own worry/concern about their child.

Don’t ever feel bad about calling the doctor’s office if you are concerned. That’s what we’re here for. Many times children get better by the time they get to the doctor’s office, and parents feel bad about bringing their child in. I’d much rather see this scenario than a situation where the illness goes unseen and gets worse.

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Though health advice offered here is provided by experts, there is no substitute for the personal care your own provider can offer. If you have medical questions or concerns, please contact your physician.